Rotors Detected by Phase Analysis of Filtered, Epicardial Atrial Fibrillation Electrograms Colocalize With Regions of Conduction Block

Podziemski, Piotr; Zeemering, Stef; Kuklik, Paweł; Hunnik, Arne van; Maesen, Bart; Crijns, Harry J.G.M.; Verheule, Sander; Schotten, Ulrich

doi:10.1161/circep.117.005858

Cited by 47 publications

(43 citation statements)

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“…Other approaches may also be chosen to arrive at this phase-space representation of the conduction patterns, for instance methods that rely on the Hilbert transform of the filtered electrogram (Kuklik et al, 2015). Caution should be applied, however, when interpreting the resulting averaged activation-phase patterns, as these approaches tend to blur the true underlying activation patterns, which can lead to the elimination of conduction block (Podziemski et al, 2018).…”

Section: Recurrence Analysis As a Tool To Identify Repetitive Patternmentioning

confidence: 99%

A Novel Tool for the Identification and Characterization of Repetitive Patterns in High-Density Contact Mapping of Atrial Fibrillation

et al. 2020

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Introduction: Electrical contact mapping provides a detailed view of conduction patterns in the atria during atrial fibrillation (AF). Identification of repetitive wave front propagation mechanisms potentially initiating or sustaining AF might provide more insights into temporal and spatial distribution of candidate AF mechanism and identify targets for catheter ablation. We developed a novel tool based on recurrence plots to automatically identify and characterize repetitive conduction patterns in high-density contact mapping of AF.

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Section: Recurrence Analysis As a Tool To Identify Repetitive Patternmentioning

confidence: 99%

A Novel Tool for the Identification and Characterization of Repetitive Patterns in High-Density Contact Mapping of Atrial Fibrillation

et al. 2020

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“…The reason for the discrepancy in the observation of rotational activation during endo-epi mapping is unclear but may relate to the differences in mapping techniques between studies. A prior mapping study suggested that phase mapping might create the appearance of a phase singularity when activation mapping indicated 2 passive WF's moving in opposite directions along a central line of block 16 . Nevertheless, the finding of transient rotational activity is consistent with other phase mapping and activation mapping studies 9,[17][18][19] .…”

Section: Discussionmentioning

confidence: 99%

Endocardial-Epicardial Phase Mapping of Prolonged Persistent Atrial Fibrillation Recordings

Lee

Kalman

Royse

et al. 2020

Circ: Arrhythmia and Electrophysiology

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Background - Endocardial-epicardial dissociation (EED) and focal breakthroughs in humans with atrial fibrillation (AF) have been recently demonstrated using activation mapping of short 10-second AF segments. In the current study we used simultaneous endo-epi phase mapping to characterise endo-epi activation patterns on long segments of human persistent AF (PeAF). Methods - Simultaneous intra-operative mapping of endo- and epicardial lateral RA wall was performed in patients with PeAF using two high-density grid catheters (16 electrodes, 3mm spacing). Filtered unipolar and bipolar electrograms (EGM's) of continuous 2-min AF recordings and electrodes locations were exported for phase analyses. We defined EED as phase difference of ≥20ms between paired endo-epi electrodes. Wavefronts (WF) were classified as rotations, single WF (SWF), focal waves or disorganised activity as per standard criteria. Endo-Epi WF patterns were simultaneously compared on dynamic phase maps. Complex fractionated EGM's were defined as bipolar EGM's with ≥5 directional changes occupying at least 70% of sample duration. Results - Fourteen patients with PeAF undergoing cardiac surgery were included. EED was seen in 50.3% of phase maps with significant temporal heterogeneity. Disorganised activity (Endo:41.3% vs Epi:46.8%, p=0.0194) and SWF (Endo:31.3% vs Epi:28.1%, p=0.129) were the dominant patterns. Transient rotations (Endo:22% vs Epi:19.2%, p=0.169; mean duration: 590±140ms) and non-sustained focal waves (Endo:1.2% vs Epi:1.6%, p=0.669) were also observed. Apparent transmural migration of rotational activations (n=6) from the epi- to the endocardium was seen in 2 patients. EGM fractionation was significantly higher in the epicardium than endocardium (61.2% vs 51.6%, p<0.0001). Conclusions - Simultaneous endo-epi phase mapping of prolonged human PeAF recordings shows significant EED marked temporal heterogeneity, discordant and transitioning WF patterns and complex fractionations. No sustained focal activity was observed. Such complex 3D-interactions provide insight into why endocardial mapping alone may not fully characterise the AF mechanism and why endocardial ablation may not be sufficient.

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“… 86 Nowadays, although some groups consistently observe relatively stable or unstable rotors during AF, 87 – 89 the other groups either do not record rotors at all or record them rarely and only short-lived. 76 , 77 , 79 , 80 , 82 , 83 , 85 , 90 – 93 Using simultaneous epicardial and endocardial surface mapping, some researches consistently observed an intramural, anatomically determined reentrant circuit during AF (without any reentry on the surfaces), 84 while other groups did not detect reentry at all (intramurally or on the surface). 78 , 81 Importantly, most of those who consistently demonstrated sustained or frequent short-lived rotors during AF used the phase mapping approach for rotor detection 87 – 89 that was recently reported to have a low specificity, usually interpreting conduction blocks as rotors.…”

Section: Electrophysiological Mechanisms Of Af: Reentry or Focal?mentioning

confidence: 99%

Investigational Anti–Atrial Fibrillation Pharmacology and Mechanisms by Which Antiarrhythmics Terminate the Arrhythmia: Where Are We in 2020?

Burashnikov

2020

Journal of Cardiovascular Pharmacology

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: Antiarrhythmic drugs remain the mainstay therapy for patients with atrial fibrillation (AF). A major disadvantage of the currently available anti-AF agents is the risk of induction of ventricular proarrhythmias. Aiming to reduce this risk, several atrial-specific or -selective ion channel block approaches have been introduced for AF suppression, but only the atrial-selective inhibition of the sodium channel has been demonstrated to be valid in both experimental and clinical studies. Among the other pharmacological anti-AF approaches, “upstream therapy” has been prominent but largely disappointing, and pulmonary delivery of anti-AF drugs seems to be promising. Major contradictions exist in the literature about the electrophysiological mechanisms of AF (ie, reentry or focal?) and the mechanisms by which anti-AF drugs terminate AF, making the search for novel anti-AF approaches largely empirical. Drug-induced termination of AF may or may not be associated with prolongation of the atrial effective refractory period. Anti-AF drug research has been largely based on the “suppress reentry” ideology; however, results of the AF mapping studies increasingly indicate that nonreentrant mechanism(s) plays an important role in the maintenance of AF. Also, the analysis of anti-AF drug-induced electrophysiological alterations during AF, conducted in the current study, leans toward the focal source as the prime mechanism of AF maintenance. More effort should be placed on the investigation of pharmacological suppression of the focal mechanisms.

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Rotors Detected by Phase Analysis of Filtered, Epicardial Atrial Fibrillation Electrograms Colocalize With Regions of Conduction Block

Abstract: Supplemental Digital Content is available in the text.

Cited by 47 publications

References 47 publications

A Novel Tool for the Identification and Characterization of Repetitive Patterns in High-Density Contact Mapping of Atrial Fibrillation

A Novel Tool for the Identification and Characterization of Repetitive Patterns in High-Density Contact Mapping of Atrial Fibrillation

Endocardial-Epicardial Phase Mapping of Prolonged Persistent Atrial Fibrillation Recordings

Investigational Anti–Atrial Fibrillation Pharmacology and Mechanisms by Which Antiarrhythmics Terminate the Arrhythmia: Where Are We in 2020?

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